Drug Diversion and Abuse: Methadone: Friend or Foe?

Cmdr John Burke

Published Online: Friday, February 1, 2008

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John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at , via the Web site www.rxdiversion.com, or by phone at 513-336-0070.

As this piece is being written,
concerns over methadone
seem to have swelled, as
reports of abuse have become more
widespread. This has been building for
a few years now, as the drug has seen
a surge in prescribing due to its low
cost and, I believe, the thought that it
had relatively low abuse potential.

Manufacturers of the 40-mg methadone
tablet, as of January 1, 2008, have
decided to withdraw this strength from
the retail market and make it available
only in health facilities and clinics that
address substance abuse. This was in
response to a recommendation by the
Drug Enforcement Administration and
is not currently mandated by the
agency. My office is in the process of
concluding a criminal case with a physician
who was illegally prescribing the
40-mg tablet, and a single pill was being
sold at $40 to $45 on the street in
southwest Ohio.

Methadone is a Schedule II drug, so
when prescribing is increased significantly,
it is clear why the abuse of the
drug also would increase, due to the
mere fact that more of the product
exists for potential diversion. This is the
case with most controlled substances,
as you might guess. It is important to
point out that the vast majority of
increase in abuse of methadone occurs
with the drugs that are being prescribed
by physicians and dispensed in
retail pharmacies. The liquid form of
methadone, commonly used in clinics
to address substance abuse, is mostly
not the potential culprit. Some abuse
will always exist in the clinics, mostly
involving the practice of allowing some
patients to take home a supply to prevent
them from having to visit the clinic
every day. Again, diversion from this
source appears to be relatively low
across the United States.

Instead, improper prescribing has
been reported as a larger problem and
a potential cause of many of the
methadone overdose deaths. Methadone
has a slow onset and long halflife,
placing those who want to get high
in potential peril. As they take their initial
dose and do not attain the high
they were looking for, they increase the
dose over several days and run the risk
of overdose and even death.

So with all of these problems, why
do we not just get rid of methadone
altogether—the world would be a better
place, right? Some groups, like
those supporting the Web site www.harmd.org, would very much like to do
that—very similar to a few radical folks
who still want to ban oxycodone
(OxyContin) from the market.

The problem with banning methadone
and other prescription drug
painkillers is that, every day, they serve
a vast number of patients who desperately
need legitimate pain relief. Estimates
suggest that less than 10% of
the individuals who ingest controlled
substances are abusing them. If my
math is correct, this means that over
90% of those individuals who are prescribed
controlled substances need
them and take them as directed.

The other point that sometimes does
not seem politically correct when dealing
with parents whose children have
died while taking these drugs is that
many of them were either taking the
drug that was not prescribed to them,
abusing what was prescribed to them,
or involved in some sort of criminal
behavior that allowed them to obtain
the prescription medications. I have
tremendous sympathy for these parents,
but it does not justify not telling
the entire truth. We have all made decisions
in our life that we wish we could
rescind. I continue to be an avid legitimate
pain-patient advocate, but it worries
me whenever these types of situations
arise.